Provider Demographics
NPI:1437133428
Name:TARDIF, CHRISTINE C (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTINE
Middle Name:C
Last Name:TARDIF
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CHRISTINE
Other - Middle Name:
Other - Last Name:DONNELLY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2202 N FORBES BLVD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85745-1412
Mailing Address - Country:US
Mailing Address - Phone:520-322-8460
Mailing Address - Fax:520-323-5742
Practice Address - Street 1:630 N ALVERNON WAY
Practice Address - Street 2:#251
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85711-1843
Practice Address - Country:US
Practice Address - Phone:520-322-8460
Practice Address - Fax:520-323-5742
Is Sole Proprietor?:No
Enumeration Date:2005-12-02
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ31311207Q00000X
CODR.0071784207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ761975Medicaid
AZ761975Medicaid
H16343Medicare UPIN